Hydroxy/ Plaquenil or Leflunomide/ Arava in combination with 15mgs MTX that is the question?

Worried about my eyes with the Hydroxy - has anyone tried both at different times with MTX and if so which seemed the better combination?

[heatherp]

Hi Tilda, I'm currently on hydroxy and 15mgs of MTX. Have been on hydroxy since diagnosis back in 2010 with no problems, but have tried both leflunomide and MTX (separately and at different times) with it. My rheumy said that MTX and leflunomide are pretty much equal strength (and both stronger than hydroxy), so I would think that taking both of those together would be more of a risk of side effects (only my opinion).

However I have heard of people being on both MTX and LEF at the same time, so maybe someone on here will answer that one!

[Hidden]

Thanks Heather - I asked this on the end of my recent blog and Polly replied that she thought Hydroxy + MTX would be safer for my liver, which is a bit raised just now and my GP thought Hydroxy would work marginally better with MTX too.

I had put this question up before Polly's reply though and it's useful hearing confirmation of this from someone who has tried both. Did you quit Leflunomide because of side effects? TTx

[heatherp]

Yes, overall I thought felt better on leflunomide until I came off it! I had a really upset tummy for most of the time and eventually my appetite just disappeared completely (as I just felt so uncomfortable after eating!). Also my lymphocytes that are traditionally low were averaging 0.5 when they should be at least 1. I also developed this rash that was worse in the sun, but didn't go completely even when not in the sun (although found I did get a rash last month when we were having that bout of good weather, and not on lef now!)...joints were great though!...

but yes since both MTX and LEF are harsh on the liver and your liver results are raised at the moment it's possibly not a great idea taking both!

[sciqueen]

Hi T

This is where you need the experience of a rheumy consultant. They would have an idea of what you most likely to tolerate.

I would say start with hydroxy, but there are others who take lef (low dose) in combination with mtx (upto 15mg). However as others have said this could raise your liver function further.

Another possibility is to stop mtx all together and start taking lef aswell as another dmard.eg hydroxy.

It's a twister hun, but starting of with hydroxy, takes months before you see any benefits 12wk+, so you will have to hang in there and be patient.

Good luck with it

I am thinking of you

Sci xx

[Hidden]

Thanks Sci and Heather - yes I know a rheumy would be the best person to decide - but I suppose he has agreed to the Hydroxy to my GP so he must have had to think about it at least.

I think the liver pulls rank and Lef is off the menu for me for the time being as other than liver I'm tolerating MTX pretty well (apart from the mood changes which hopefully will settle down).

Yes I will hang in there with the Hydroxy when I start on Monday and give it 3 months, after a GP eye test he said I'd need too. I asked him about my ankle and he said nothing would show up on x-rays at this stage even if it does mean that the RA is active, which he thinks it probably does. Elbow is also playing up a little more each day - both on the left which is weird. It stings like anything on the elbow bone when I try to stretch it out. Both wrists now very achy sore so I hope I'm not going to flare up now I've come down a dose on the MTX.

Ho hum and there's gale force winds here tonight - fun!

Husband spending a lot of time looking at maps and street views in Edinburgh and Glasgow these days?!

TTx

[salem974]

I take methotrexate, leflunomide and plaquenil. I was also taking steroids but Dr wanted me off the prednisone. Three months and my hands are swollen and sore with other pain too. My eye dr told me that there is a slight chance of plaquenil would affect my eyes. Get checked once a year. Dr is now talking about using biologics next because meds are not working.

[Hidden]

Oh dear Salem poor you that doesn't sound too good - hope you get the anti-tnf though many seem to flourish on them. I'm hoping that adding in the Plaquenil sorts my hands out and the rest of me too. TTx

[Hidden]

I have been on Plaquenil for years and its fine. With Sulfasalazine and then MTX added.

I have eye tests once a year, and have no problems.

I do get Sjogrens eye problems, but that's nothng to do with Plaquenil.

(Gale force winds? That means changes in atmospheric pressure. That's when my elbows play up!)

[Hidden]

Thanks Phoebe - my elbow has joined my ankle in being a constant - perhaps its the constancy of the wind up here that's the problem?! TTx

[joan_w]

I have been taking the highest amount allowed of both MTX and Leflunomide for some years now and have not had any side effects to speak of. They both failed to keep my RA in check so now I take an anti-TNF as well.

I haven't had any eye problems at all and I am diabetic so have a very thorough eye check every year.

Jo

[Hidden]

Hi Joan - I think it's only the Hydroxy/ Plaquenil that causes eye problems sometimes not the Leflunomide or MTX - my optician told me that if I go on it I will qualify for free NHS eye tests yearly so that's something I suppose. Good to know that lef and mtx combined haven't given you side effects in case the hydroxy and MTX combined don't help my RA enough either. Judging by my aches and pains today (I think I'm flaring a bit) I do need the Hydroxy to make a big difference. TTx

[Tinwoman2]

Hi Polly, I'm on all 3. I am doing well enough to walk & participate in an exercise class 3 times a week. I get the occasional pain or flare, but I've gotten to a good place by taking all 3 meds. I take plaquenil daily, Arava/leflunomide on Tues & Fri's, and Methotrexate 8 on Sundays. And I go to an opthamologist twice a year, per my Dr's instructions.

[Hidden]

It's Tilda not Polly who asked this question Tinwoman! It's great that you are doing so well on all these meds. Unfortunately I've had my MTX dose lowered because of raised liver - and perhaps this is the reason I'm in more pain today than I've had for sometime. But your story is inspiring re the drugs - I've been lucky most of the time that I've been able to walk and exercise a lot but not today. TTx